Esophageal dysmotility

[keelton]

I was wondering how many of you are dealing with esophageal motility issues. My esophageal muscles are not working properly and food gets stuck when i swallow. I have had manometry testing which confirms this.    Is this common In Sjogrens?

[sixty]

Keelton, I have never heard of what you have, but for the last 1 or 2 years I cannot clear my throat.  I'm assuming it's sjogrens just because it never used to be a problem and I'm thinking it's because my saliva has lessened to the point of making it more mucusy and harder to clear.  After a few hours in the morning I'm finally able to clear it a bit more maybe because I've ingested plenty of water.  As far as swallowing there are times when it's scary because food gets stuck, but I've always been able to get it down as long as I've had water nearby.  What is manometry testing?

[gurs]

Sure I have this. I was just tested and diagnosed with gastroparesis. My esophagus not working either. Its very scary. Nothing works in my entire GI system. No one understands just how severe this can be and I believe its all CNS related.
I don't think much can be done either. I decided not to do any further testing because I don't think there is any treatment.
I eat very soft foods, stay away from raw veggies, etc.

Interesting to see what your tests will show..good luck!

Gursie

[Carolina]

I have what the radiologist called 'an incompetent esophagus', also called esophageal dysmotility.

It was diagnosed in 1997, but I had experienced the problem for years before without knowing what was going on.

My mother had it, too.

It is much more of a nightmare now that my mouth and throat are very dry.

The worst is when I am eating something 'sticky' like turkey breast or a bagel.  I eat a few bites, without thinking at all about the problem.  Then there is a bite that just doesn't go down!  There is now a growing sense of pressure as my swallowed saliva increased the bulk of food completely stopped.

I can excuse myself, go to the bathroom and reverse swallow to force the food out.  Or I can wait and wait and wait, hoping for the blockage to end and for the food to slide down.

I have had TWO episodes of the same dysmotility in my large intestine.  The pain is overwhelming and the blockage can last for hours.  The second time it happened I went to the hospital after 6 hours, a CT scan was made, and the blockage was seen.

I was in the hospital for three days, with an NG tube (nightmare  of its own variety).  If this blockage had not resolved, surgery would have been necessary to clear it.  The blockage cleared Saturday afternoon, but I was kept for 24 hours more to insure it was gone.

That was in 2010, and I haven't had another intestinal episode, but I never know when it might happen again.

Ain't we got fun?!

Hugs,  Elaine

[keelton]

Thanks for the replies!   Do you guys know what caused your esophagus not to work?  Is it sjogrens or some other disorder? 

[Jasper]

From Medscape:

Rheumatology
Dysphagia and Other Manifestations of Oesophageal Involvement in the Musculoskeletal Diseases
N. J. Sheehan

"Dysphagia occurs in three-quarters of patients with Sj?gren's syndrome[15,16] and may be related to a combination of lack of saliva and oesophageal dysmotility. As well as reducing lubrication and hence prolonging pharyngeal transit time, absence of saliva predisposes to dental caries and to oral Candida, both of which may impair mastication;[17] it also diminishes the acid clearance capacity of the oesophagus.[18]

Defective peristalsis has been demonstrated in one-third or more of patients with primary Sj?gren's syndrome.[16,19] Decreased or absent contractility has been shown in the upper third of the oesophagus,[20] and UOS impairment may be more severe than in the other connective tissue diseases.[1] Other patterns of oesophageal dysfunction have also been described,[19] including achalasia.[21] Oesophageal webs are found in ∼ 10% of patients.[15]

Oesophageal symptoms do not correlate well with manometry or salivary secretion[16,18,22] and other unknown factors may be instrumental in the dysphagia of Sj?gren's syndrome.

It has been postulated that the discrepancy between subjective swallowing difficulties and the lack of objective signs of pharyngeal and oesophageal dysmotility as assessed by videoradiography may be related to impaired parasympathetic function.[23] "

[cccourt1942]

keelton:  I wish I could offer you more help than this, but here goes:
      My profession is speech/language pathologist...needless to say retired. 
      That being stated, I have been out of school for over 40 years.  Needless to say all of this info is basic...and does not allow for information I didn't learn.  None the less, I think it could help you.
      1st)  When I was in school, one trained to do therapy in all settings.  One of those was within hospitals and (at the time) convalescent settings.  Alzheimer's was added much after my core education.  The ONLY therapy I recalled (during all of my practice in school setting) for "hospital" or senior citizen is for "swallowing."  I wish I could remember if we learned the term esophageal motility..but can't/don't.  Makes no diff as the therapy is the same:  Gentle massage (yes) by fingers DURING the act of swallowing so as to feel the muscles relax....and help patient to slow down the process and not "gulp" or dreaded restriction.   Fear of choking.  When you are young and you are learning this kind of stuff, it seems so simple.  Well...let me tell you: It IS simple when everything works and the swallowing process is not impeded by something called Sjogren's.  I can't say if esophageal mucosa was ever discussed...probably was as two anatomy courses were required.  Again, makes no difference.  When that mucosa is compromised (as ours is) it doesn't matter how "relaxed" you are...on yourself...or me, a therapist working with a patient...this won't work without the all important mucosa.  Or ....an alternative for what we discuss here as our little swallowing helpers.  Actual muscle loss is rare.  (as I recall).  Muscle delay is common.  Thus the method I described.  The diagnostic label for this treatment is dysphagia.   Here's the corker:  I did this maneuver on myself for I'd say nearly 15 years.  I was convinced I was eating too fast.  That was probably true..but not all circumstances.
      2nd) Swallowing "helpers":  we have discussed what we keep in the fridge to help the food go down.  My personal fave is sour cream.  Some use gravies, and other sauces.  I love poppy seed dressing on fruit....especially citrus (grapefruit and "cuties").  It helps.  Watch the consistency of what you choose to swallow.   My list of foods is extremely small.   From reading from other contributions here, most of us have favored foods for ease of eating.  btw:  My foods list narrowed over a long period of time.....likely two decades. 
   Last: I am 74.  What amazes me the most is the number of people I have known in my life who approached me as they were being treated for dysphagia.  Now...at my age and with a SjS dx, I wonder how many had SjS.  I would imagine a large #. 
   
Sixty:  The clearing of the throat is maddening.  Was taking in 7 plays in 6 days week before last...and had my Ricoh's stuffed in my bag!  Thank goodness I remembered to take Mucinex with me.  I took half in a.m. and half at night.  It is a little difficult to take on the road as you MUST drink lots of water with it.  It works...and don't ask me to explain.  All I know is I forget about it when it comes on...and when I remember the Mucinex, I am always so relieved.  btw: a GP gave me the mucinex hint.  Go figure.

     Best to all in this almost midpoint of dog days of summer!
Sjoldier c3
     

[warmwaters]

I've been tested for this.  Don't have it, though I have other CNS issues.

One other observation - our lack of saliva also means that some foods are not as broken down as they would be if we had saliva. Saliva has an enzyme that helps to break down carbohydrates while we are chewing. Water may soften things, but doesn't help break them down.

So the food may be more solid that other people have as they try to swallow.

So... small bites, soft foods, lots of water, chew thoroughly. 

For example, I use to love steak, but can't get it throughly chewed enough to swallow. Even with lots of sips of water.

[Tharrell]

I have all the signs and symptoms of gastroparesis, but tested negative on that test. I have been complaining of globus sensation for years, but two barrium swallow tests showed everything was normal. Finally a gi ordered an esophagram that showed everything I eat and drink rises straight back up into my esophagus. Yet the little clapper in the stomach that prevents food from going up is working normally. He also ordered a ph/imedinance testing which showed I have a jackhammer esophagus explaining the severe cramping pain and globus sensation. Treatmentwise I'm stuck between a rock and a hard place. To treat the jackhammer I would make the GERD worse. Never mind that I'm already on a double dose of amlodipine for raynauds which is also used to treat the jackhammer. It doesn't help. If I treat the severe GERD I would make my GERD worse.
So right now I'm at loss.